This summary shares learning from the third fortnightly learning logs in our video consultations insight project. It includes responses from 30 participants who share their own experiences of implementing this service, and what they are hearing from others as they do. This blog builds on our two previous summaries – from week two and week four of this project – and a set of webinars in which participants explored the themes of monitoring and evaluation, and managing uncertainty.

Key themes from the third learning logs (week ending Sunday 17 May)

• While the excitement, sense of opportunity and rapid progress that we described in earlier blogs is still apparent, the most recent learning logs convey more concerns and scepticism about the longer-term role for video consultations.
• Issues underpinning this concern include unease around digital and health inequalities, increased concerns about quality, feelings of under-preparedness for the resumption of routine services, issues with technology, access to equipment and staff stress and wellbeing.

Continued progress

Building on the foundations of the last two months, many participants are continuing to make progress with rolling out video consultations.

• Participants highlight the benefits of using improvement tools to support responsive and iterative approach
• Patient feedback is generally positive
• Pathways and processes are being better integrated into virtual ways of working (such as e-forms, digital infrastructure, e-prescribing)
• Services are starting to expand use of virtual consultations to resume non-urgent/elective care

I love watching it grow. This has been a great opportunity to put video consultation out there at large. Now we get to prove its concept, and improve it as we go to ensure sustainability.

Growing concerns

However, some participants have reflected that the uptake of video consultations is not as wide as assumed by policy makers and system leaders. The learning logs also convey more scepticism about the longer-term role for video consultations. This is particularly evident in secondary care where there is more variation across different specialties and services.

We’ve identified five issues that risk stalling progress and impacting on longer-term sustainability:

1. Increasing unease about inequalities
   Participants raised fears around unmet needs due to digital exclusion and accessibility related to specific health conditions, and concerns that this will exacerbate health inequalities. We will be exploring this issue further in the next learning logs.
2. Growing concerns about quality and safety
   Participants are identifying examples where video consultation appears to improve the quality of the consultation. However, they express growing concerns about “what is being missed” by not seeing people face to face, and whether it is appropriate for particular groups and services.

There is a feeling we are ‘shortchanging’ our patients, and there is anxiety among staff that this will not be tolerated indefinitely.

3.  Feeling under prepared for resuming services
Many participants report still being in the early phase of implementing video consultations but are expected to start resuming more services. Participants are concerned that some of the “shaky foundations” of digital infrastructure and rapidly-developed processes and pathways that haven’t been optimised for working virtually could cause issues with increased volume. Moreover, the pausing of much elective care was a key enabler in giving clinicians time to engage with the change to video consultations. Without this, implementing teams may find it harder to get additional staff on board.

Big pressure now to think about the post-COVID future when we’ve barely started in practice with rollout […] Just feels premature.

4.  Issues with technology and access to equipment
This relates to variable access to hardware across different organisations with some not having access to the necessary laptops, tablets, webcams or headsets; platform instability and connectivity (feared to increase as roll out increases) and services making use of different platforms and providers for different purposes. On the latter point, while this has enabled uptake and experimentation, we recognise that it may pose a threat to consistency and coordination in the future.

5.  Concerns about staff wellbeing and longer-term job satisfaction
Long hours, isolation, fatigue and stress were all more frequently mentioned in this fortnight’s logs than previously, which highlights to us real concerns around staff wellbeing. This relates to the implementing teams’ own wellbeing, but is also feared to be a barrier for other staff to engage with the work. In the longer-term, participants are starting to flag concerns about job satisfaction if remote working and video consultations become an increasing part of working life (in contrast to the feelings shared in previous logs, which were more positive on the potential improvements video consultations promise on this front).

I’m beginning to see a real weariness with this way of working and concerns about how we get the right balance in the future.

Tackling these challenges

Given the continued progress being made and people’s commitment to improving this work, we don’t want to overstate the challenges. Participants recognise the benefits: many are gathering evidence of positive outcomes and are increasing their confidence for working in this way. However, the five areas listed above will becoming increasingly important and warrant attention from organisation and system leaders, as much as from implementing teams.

What’s next?

Through future learning logs and webinars on this topic, we will be exploring the following questions further:

• What are people doing to address inequalities? What are the different aspects of inequality that are of specific concern?
• What are the best ways to build capacity and increase confidence among staff beyond the early adopters to increase the services and specialities engaging?
• What workflow and technology responses and capability building are people putting in place to address issues with digital infrastructure?
• What more needs to be done to understand the implications for teams and individual roles of the shift to virtual working? How are organisations understanding and supporting staff wellbeing through this and other changes?

Get in touch or join the Video Consultations Special Interest Group to share your views.

Read the previous blogs from this project on our initial insights and building for the long term.

And if you’re interested in our work to help improvers capture, evaluate and assess rapid improvements, sign up to our online workshop on 29 May.